Recently, it is increasingly suggested that pathological narcissism is the outcome of heredity (genes) or an epigenetically determined expression of genes, including in brain abnormalities. Diathesis-Stress Models and Differential Susceptibility Hypotheses are used to attempt to account for NPD.

What causes us to question the consensus regarding narcissism since 1915?

Pathological narcissism is a life-long pattern of traits and behaviours which signify infatuation and obsession with one's self to the exclusion of all others and the egotistic and ruthless pursuit of one's gratification, dominance and ambition.

As distinct from healthy narcissism which we all possess, pathological narcissism is maladaptive, rigid, persisting, and causes significant distress, and functional impairment.

Pathological narcissism was first described in detail by Freud in his essay "On Narcissism" (1915). Other major contributors to the study of narcissism are: Melanie Klein, Karen Horney, Franz Kohut, Otto Kernberg, Theodore Millon, Elsa Roningstam, Gunderson, and Robert Hare.

Pathological narcissism is a reaction to prolonged abuse and trauma in early childhood or early adolescence. The source of the abuse or trauma is immaterial - the perpetrators could be parents, teachers, other adults, or peers. Pampering, smothering, spoiling, and "engulfing" the child are also forms of abuse.

To identify the role of heredity, researchers have resorted to a few tactics: they studied the occurrence of similar psychopathologies in identical twins separated at birth, in twins and siblings who grew up in the same environment, and in relatives of patients (usually across a few generations of an extended family).

Tellingly, twins - both those raised apart and together - show the same correlation of personality traits, 0.5 (Bouchard, Lykken, McGue, Segal, and Tellegan, 1990). Even attitudes, values, and interests have been shown to be highly affected by genetic factors (Waller, Kojetin, Bouchard, Lykken, et al., 1990).

A review of the literature demonstrates that the genetic component in certain personality disorders (mainly the Antisocial and Schizotypal) is strong (Thapar and McGuffin, 1993). Nigg and Goldsmith found a connection in 1993 between the Schizoid and Paranoid personality disorders and schizophrenia.

The three authors of the Dimensional Assessment of Personality Pathology (Livesley, Jackson, and Schroeder) joined forces with Jang in 1993 to study whether 18 of the personality dimensions were heritable. They found that 40 to 60% of the recurrence of certain personality traits across generations can be explained by heredity: anxiousness, callousness, cognitive distortion, compulsivity, identity problems, oppositionality, rejection, restricted expression, social avoidance, stimulus seeking, and suspiciousness. Each and every one of these qualities is associated with a personality disorder. In a roundabout way, therefore, this study supports the hypothesis that personality disorders are hereditary.

This would go a long way towards explaining why in the same family, with the same set of parents and an identical emotional environment, some siblings grow to have personality disorders, while others are perfectly "normal". Surely, this indicates a genetic predisposition of some people to developing personality disorders.

Still, this oft-touted distinction between nature and nurture may be merely a question of semantics.

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